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Oncology Nursing: Scope and Standards of Practice 1

Scope of Oncology Nursing Practice 2

Introduction 3

The Oncology Nursing Society (ONS) has been defining the scope and standards for 4

oncology nursing practice since 1979. Over the years, these standards have evolved to reflect 5

changes in cancer care in general and oncology nursing practice more specifically. The purpose 6

of this current document, Oncology Nursing: Scope and Standards of Practice, is to provide 7

oncology nurses, administrators, legislators, other professionals and the public with a clear 8

description of the appropriate and expected scope of oncology nursing practice. Oncology 9

nursing practice will be addressed at three levels: the registered nurse (RN), the graduate-level 10

prepared RN and the advanced practice registered nurse (APRN) and the requirements for 11

practice and expected competencies will be detailed for each of these practice levels. 12

Cancer is the second leading cause of death worldwide and while the incidence of cancer in 13

the United States has been slowly declining, it is estimated that cancer incidence throughout the 14

world will rise by 70% in the next twenty years. In the United States along, it is estimated that 15

over 1.6 million people will be diagnosed with cancer in 2017 or 4600 people diagnosed with 16

cancer each day. In addition, cancer survival has steadily increased since 1991 resulting in 17

growth in the population of cancer survivors. 18

As of early 2016, there were 15.5 cancer survivors alive in the United States, most of whom 19

were previously treated with no current evidence of cancer (ACS, 2017a) These survivors have 20

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short and long-term needs that require qualified healthcare providers to detect and manage these 21

challenges (Smith, Yates and Ewing, 2017). 22

Oncology nursing encompasses nurses who work in a wide variety of roles and settings, but 23

all have a common purpose: to help people at risk for or with a cancer diagnosis to achieve the 24

best quality of life and outcomes (ONS, 2016a). This includes nurses who identify as an 25

oncology nurse, but also those who care for people at risk for or with a cancer diagnosis in non-26

traditional, generalist and other specialty areas. 27

Historical Perspective of the Nursing Specialty 28

The fight to advocate for people with cancer in the United States began with the building of 29

the first specialized cancer hospital, in New York City, in 1887. Unfortunately, the stigma of 30

cancer as an incurable, and likely contagious disease earned the hospital a poor reputation, 31

despite its full occupancy within the first month of opening its doors. Concurrently, the first 32

research laboratory devoted to cancer began its work at the University of Buffalo, and in 1913 33

eventually led to the development of a hospital associated with the research facility. In 1912, 34

another hospital devoted to the research of cancer and the care of patients with cancer was 35

opened, in Boston, and was associated with the Harvard Medical School. (McDonnell, 2011). 36

These early hospitals were crucial to the advancement of understanding about the disease, but 37

were still considered places where individuals with cancer go to die. 38

By the 1920s and the advancements of technology and medical/surgical specialization, 39

hospitals had become centers for the development of new surgical and radiological techniques to 40

treat cancer, but remained unwilling to accept patients with advanced cancers due to the care 41

burden that they represented; during this time, most people with advanced cancers died at home, 42

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in the care of a public unable to adequately provide care. Subsequently, the need for and number 43

of homecare nurses caring for people with cancer grew (Lusk, 2011). 44

Over the course of the first 30 years of the 20th Century, as death rates for infectious diseases 45

declined, the focus on cancer as a public health concern increased. The American Association for 46

the Control of Cancer, a precursor organization to the American Cancer Society, devoted effort 47

to educating the public on early recognition of cancer, when cure may be possible (American 48

Cancer Society [ACS, 2017b). Concurrently, nurses were heavily recruited to join the “war on 49

cancer” to educate themselves about cancer, inform the public about early recognition, and to 50

care for those with advanced disease. Nursing care of patients with cancer was seen as occurring 51

in two different categories: those that require post-operative care for operative cancers, and those 52

that require palliative care for inoperative cancers (McDonnell, 2011). As technologies 53

advanced, and with the development of radiation therapy, cancer treatment began moving from 54

end of life care at home to the hospital setting, and specialized nurses were in even greater 55

demand. (Lusk, 2011). 56

Evidence supports that early oncology nurses were charged with critical responsibilities 57

associated with the care of patients with cancer, including early recognition of oncologic 58

emergencies, intense symptom management (occurring in the absence of antibiotics or 59

antiemetics), and even recognized exposure to radioactive sources in the course of their duties 60

(Lusk, 2011). Care of patients with cancer was recognized by cancer care physicians of the time 61

as intense and demanding work, requiring a unique set of specialized skills (Lusk, 2011). 62

By the early 1940’s, the “curative era” of cancer care began, as clinical trials using nitrogen 63

mustard to treat Hodgkin lymphoma commenced. Although venous access was at this time 64

strictly the domain of physicians, oncology nurses began including admixture of 65

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chemotherapeutic agents in preparation of physician administration of them as part of their duties 66

(Haylock, 2011). By the 1950’s nurses in research hospitals were administering cytotoxic agents 67

intravenously routinely. 68

As antibiotics and antiemetics emerged, nursing care of the oncology patient changed 69

significantly, as even marginally effective supportive care drugs affected the course of patient 70

outcomes. The role of the oncology nurse changed from traditional bedside care to more 71

complex integration of technological advances and psychosocial care. However, throughout the 72

1940s cancer nursing as a specialty was supported through initiatives such as the Russell Safe 73

Foundation to identify current and future nursing needs for people with cancer, and an increasing 74

recognition of the oncology nurse’s role in psychosocial support emerged (Haylock, 2011). 75

From 1950 to 1980 cancer treatment consisted of extensive surgery or radiation therapy, or 76

intensive cytotoxic drug therapy, or a combination. The toxicities associated with these regimens 77

required skilled nursing care management by highly specialized nurses. Further, oncology nurses 78

routinely administered IV chemotherapy, operated radiation therapy equipment, and provided 79

intensive patient and family education and psychosocial support. Although recognized by the 80

1940’s as integral to patient and family needs at end of life care, it was not until 1950 that a 81

commission was established to study the effect of nursing care to patients at the point in the care 82

continuum (Haylock, 2011). The commission concluded that more nursing time and enhanced 83

quality of nursing care was needed in both hospitals and in homes to meet the needs of this 84

patient population. 85

In 1937 the National Cancer Institute was established with a charge to conduct and encourage 86

research on cancer and to provide training and instruction (National Cancer Institute [NCI], 87

2016). As an outgrowth of this charge, the Cancer Chemotherapy National Service Center was 88

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created in 1955, with a subsequent rapid growth in clinical trials in the 1960s. Throughout the 89

1960s, as it became clear that many nurses would at some point be caring for individuals 90

receiving chemotherapy agents, the need for education of nurses about cancer and cancer care 91

became more pronounced. Although no formalized definition of oncology nursing was yet 92

established, nurses began to fulfill roles in clinical trials teams, reporting outside of the nursing 93

administrative structure and directly to the principle investigator. These relationships were 94

foundational specialty training for oncology nurses. The Nurse Training Act of 1964 encouraged 95

development of master’s degree training programs and nurse enrollment in them. This legislation 96

was crucial to the founding of many specialty nursing organizations at the time, including the 97

Association of Pediatric Oncology Nurses in 1974 and the Oncology Nursing Society in 1975 98

(Lynaugh, 2008). 99

Nurse practitioner and other advance practice roles in oncology nursing began to develop in 100

response to a shortage of acute care physicians, which began in the 1960s and became critical in 101

the 1970s. Coupled with this physician shortage was an increasing public awareness of expanded 102

roles for women, promoted by the woman’s movement in that decade. As a response to public 103

need, advance practice education for oncology nurses began (Wilson, 2005). 104

The Oncology Nursing Society’s (ONS) priorities have focused on advancement of the 105

specialty of oncology nursing by defining the scope of the oncology nursing and providing 106

education and practice resources to oncology nurses at all levels. In 1979, ONS published the 107

first set of standards, Outcome Standards for Cancer Nursing Practice, in collaboration with the 108

American Nurses Association. This was followed by several revisions between 1987 and 2013 109

which were titled Statement on the Scope and Standards of Oncology Nursing Practice. In 110

addition, to assure the consistency and standardization of educational preparation for oncology 111

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nurses, ONS has Standards of Oncology Nursing Education: Generalist and Advanced Practice 112

Level since 1982. 113

In 1981, ONS began a certification task force to explore the development of an oncology 114

nursing credential that recognizes nursing expertise in oncology nursing. The Oncology Nursing 115

Certification Corporation (ONCC) finalized its corporate status in 1984, and the first Oncology 116

Certified Nurses (OCN®) received the credential in 1986 (Nielsen, Scofield, Mueller, Tranin, 117

Moore, & Miller Murphy, 1996). 118

Scope of the Oncology Nursing Role 119

Cancer is a complex, chronic group of diseases that require care in many settings across the 120

disease trajectory. Therefore, oncology nursing roles most commonly include: direct care 121

provision in inpatient, ambulatory, home and hospice setting; patient navigation; patient 122

education; clinical research coordination; prevention and early detection; quality improvement; 123

management and leadership; and pharmaceutical industry support, among others. Despite the 124

diversity of roles and practice settings, there are many commonalities in the scope of the 125

oncology nursing role across cancer types. 126

Areas of focus for oncology nursing have been described through several role delineation 127

studies (RDS) performed by the Oncology Nursing Certification Corporation since the mid-128

1990s. While most often performed to support the certification process, RDS’ help identify the 129

tasks, knowledge and skills needed to perform a specific role safely and effectively (Duke and 130

Meyer). For oncology nursing, the Oncology Certified Nurse, Advanced Oncology Certified 131

Nurse Practitioner and Advanced Oncology Certified Clinical Nurse Specialist test content 132

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outlines provide the best guidance in determining universal areas of focus for oncology nurses 133

(ONCC website – test outlines). These 15 areas of focus include: 134

• Health Promotion, Screening, Early Detection and Genetic Risk; 135

• Patient and Caregiver Education; 136

• Factors in Treatment Planning; 137

• Safe Administration of Cancer Treatments; 138

• Symptom Management; 139

• Psychosocial Support; 140

• Oncologic Emergencies; 141

• Survivorship; 142

• Palliative Care; 143

• End-of-Life Care; 144

• Coordination of Care; 145

• Interprofessional Collaboration; 146

• Evidence-Based Practice; 147

• Legal and Ethical Issues; and, 148

• Patient and Caregiver Advocacy. 149

Oncology nurses specialize in care of patients with specific cancer diagnoses (e.g. leukemia), 150

treatment modality (e.g. radiation), or aspect within the continuum of cancer care (e.g. screening 151

or hospice). The cancer care needs of the individual or community and the role of oncology 152

nurses are interrelated. Influencing factors are the population being served including but not 153

limited to gender, age, social, cultural and economic demographics, available resources, location 154

or environment of care, risks and rates of specific cancers inherent to the region, nurses’ level of 155

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education or training, and evolution of science and technology related to detection and treatment 156

of cancer. 157

Populations served by oncology nurses 158

Population at Risk for Cancer 159

Prevention and early detection are key to decreasing the occurrence, morbidity and mortality 160

from cancer. Institutions may employ nurses specializing in oncology to oversee and provide 161

information, education, and services to engage with groups and individuals at risk. Oncology 162

nurses in these settings use evidence based information about lifestyle and other cancer risks to 163

develop and implement preventative services. These services may include tobacco cessation 164

programs, vaccinations to prevent infection with hepatitis and human papilloma viruses, dietary 165

and exercise interventions to help patients achieve a healthy weight among others. 166

Oncology nurses also promote early detection of cancers, especially those with evidence-167

based screening procedures. For diseases such as breast, cervical, colorectal and skin cancers, 168

oncology nurses advocate for and provide or refer for screening activities. Other risk factors that 169

impact the need for and timing of screening procedures may include exposure to occupational or 170

environmental hazards, first line female relatives with breast cancer, heavy alcohol consumption, 171

and personal or family genetic history (e. g. Lynch syndrome). In addition, because 87% of 172

cancers in the United States are diagnosed in those aged 50 years or older, advancing age is a 173

risk for adult cancers. (ACS, 2017a). 174

Since screening and early detection often occur in primary care settings, oncology nurses are 175

in a role of educating the public and primary care providers. Primary care and other generalists 176

need information and referral resources for appropriate screening measures based on relative risk 177

as well as general risks. 178

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Population Diagnosed with Cancer 179

Individuals diagnosed with cancer are cared for by oncology nurses during the diagnostic, 180

staging, or treatment planning phases. Diagnosis may be made following routine screening, 181

problem focused medical visit, or in some cases an incidental finding during an unrelated 182

medical test or examination. The diagnosis of cancer is almost universally reported as a life 183

changing event. Oncology nurses have the responsibility to coordinate tests and appointments, 184

provide education and information, and offer emotional support to the patient and significant 185

others. 186

Population Receiving Treatment for Cancer 187

After diagnosis, staging and treatment planning have been established, oncology nurses have 188

a role in providing care during, between and following treatments to this population. Cancer 189

treatment modalities include surgery, radiation, chemotherapy, biotherapy, targeted therapy, and 190

immunotherapy. Therapy may be local or systemic, based on diagnosis, stage, patient related 191

factors and available resources. Patients undergoing treatment do not have universal access to all 192

known or recommended therapies. Country, of origin [e.g. LMIC vs. high income (HIC)], and 193

often geographic location within a nation (e.g. rural vs urban), can dictate available options and 194

which individuals in need receive treatment. Financial toxicity has been identified as a barrier to 195

treatment and can include uninsured or underinsured groups and individuals. Disparity of 196

resources across the globe also impact access to recommended treatments and care. 197

Population Eligible for Clinical Trials 198

Individuals can be eligible for clinical trials at any point along the cancer care continuum. 199

Aims of these trials are to evaluate new approaches to prevention, early detection, treatment, and 200

symptom management as they relate to cancer. Clinical oncology research nurses may specialize 201

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in cancer and engage in research sponsored by institutions, agencies, pharmaceutical/industry or 202

collaborative research groups. Oncology nurses provide a wide variety of services to people 203

interested in or participating in clinical trials such as recruitment, education to patients, 204

caregivers and colleagues, assessment and documentation of eligibility, adverse events and 205

disease response, coordination of study requirements, management of complications of study 206

interventions, collection of study specific data and other activities as appropriate to the specific 207

study, patient population and institution. 208

Population Eligible for Palliative or Hospice Care 209

While often thought of as similar is focus, palliative and hospice care may have different 210

goals. Palliative care is a “special kind of patient-and family-centered healthcare that focuses on 211

effective management of pain and other distressing symptoms, while incorporating psychosocial 212

and spiritual care according to patient and family needs, values, beliefs and culture(s)” (NCCN, 213

2017). It is the position of the Oncology Nursing Society that all patients with cancer may 214

benefit from palliative care and that it “should begin at the time of diagnosis and continue 215

throughout bereavement (ONS, 2016c). 216

When cancer is advanced, the person is not responding to or tolerating treatment, or co-217

morbidities limit treatment options or at the end of their life, palliative or hospice care may be 218

the best option. Hospice is a multidisciplinary care model for symptom management when life 219

expectancy is estimated by the physician to be less than six months (NCCN, 2017). Referrals to 220

hospice have reduced hospitalization and high intensity care at the end of life (NCCN,2017). 221

Palliative and hospice care are not defined by the setting but by patient need. Because oncology 222

nurses possess competencies essential for palliative and hospice care, they are skilled at 223

identifying the need and making referrals or providing the needed care. 224

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Population as Cancer Survivors 225

Based on the cancer survivorship model of Fitzhugh Mullen, cancer survivorship begins at 226

the moment of diagnosis and extends for the remainder of the person’s life (O’Brien, 2014). 227

Mullen identified three phases that distinguish the individual’s position on the continuum of 228

cancer care related to disease and treatment. Survivors are in the acute phase beginning with 229

diagnosis until the completion of active treatment. The extended phase begins at the end of active 230

treatment and includes the months and years the person is under active surveillance for disease 231

progression, relapse or recurrence. The person enters the permanent phase when the likelihood of 232

treating active disease or recurrence is deemed to be low. 233

Oncology Nursing Practice Environments 234

Oncology nurses practice in a variety of settings and at times follow individuals across 235

multiple care settings. They have roles in the community for education and screening. Oncology 236

nurses practice in university, community, free standing, or government health care centers. 237

Agencies and organizations for population health or research, and medical and pharmaceutical 238

companies also employ oncology nurses for cancer specific collaboration. At times, the oncology 239

nurse is engaged in virtual care (e.g. phone triage, help lines, follow up for clinical trials or other 240

data gathering). 241

Community 242

Oncology nurses may work with private or community agencies and organizations to 243

develop, implement and track prevention and early detection activities. They may also be 244

dedicated to home care or home hospice visits. Oncology nurses may be part of a team with other 245

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healthcare providers and or staff with business, sales, marketing or healthcare science 246

background. 247

Clinical Care Settings 248

Diagnosis, treatment, symptom and side effect management occur primarily in an inpatient or 249

ambulatory oncology setting. The choice of setting will depend upon the patient’s physical 250

status, type of cancer, treatment modality and intensity as well as anticipated and actual side 251

effects and symptoms. Oncology nurses working in these settings may serve dedicated 252

populations including site specific cancers, such as gynecologic, breast or hematologic 253

malignancies, or focus on treatment specific interventions, such as surgery or radiation therapy. 254

In addition, oncology nurses may work on dedicated units such critical care areas or units 255

dedicated to hematopoietic stem cell transplant or clinical trials. 256

Many oncology nurses work in the ambulatory care settings, such as physician offices, 257

ambulatory clinics and infusion centers. These setting may be affiliated with acute care facilities, 258

privately owned, or free standing. Oncology nurses in these settings provide patient assessment 259

before, during and after treatment, develop and implement plans to manage symptoms and side 260

effects of treatment, identify needs for additional services or support and facilitate referrals, 261

educate patients and their caregivers, monitor patient outcomes and change their approach as 262

new issues arise. In addition, oncology nurses in both acute and ambulatory settings administer 263

systemic chemotherapy, targeted therapy and immunotherapy as well as injections, transfusions, 264

antibiotics and other parental pharmaceuticals. 265

Oncology nurses are also active in multidisciplinary palliative and hospice care in these 266

settings. Diagnostic and procedural departments also rely on oncology nurses. Medical imaging 267

where mammography, breast ultrasound, breast MRI and biopsies are performed often employ 268

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oncology nurses to assist women in the process and procedures for timely testing to confirm or 269

rule out breast cancer. 270

Non-Clinical Settings 271

Because of their expertise in the cancer process, treatment and management of cancer 272

patients, oncology nurses are also recruited into non-traditional roles. Oncology nurses work for 273

commercial and non-profit organizations as research coordinators and specialists, educators, 274

clinical support personnel, editors and content developers, among others. 275

Requirements to be an Oncology Nurse 276

Professional nurses who practice in oncology are prepared and licensed at all levels, from 277

prelicensure (bachelors, associates and diploma) through masters and doctoral preparation. 278

Prelicensure level programs are designed to prepare nurses for generalist nursing practice and 279

most do not focus on a specific clinical area or patient population. Therefore, entry into oncology 280

nursing practice requires cancer-specific knowledge and clinical competence related to the 281

unique need of people with cancer and the specific roles of oncology nurses. 282

Registered Nurses 283

Oncology nursing provides a wide variety of opportunities for specialization and sub-284

specialization. Each area of specialization may require additional learning and skill development 285

focusing on the individual patient population, practice setting and role requirements. 286

Educational preparation: 287

RNs who choose to practice in oncology have many opportunities for using their general 288

nursing skills to care for people at risk for or living with cancer. To practice in oncology, RNs 289

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must have completed an accredited diploma, associate degree or baccalaureate degree nursing 290

program and have an active RN license. However, RN pre-licensure programs prepare nurses for 291

generalist practice and most include minimal content or experience related to caring for people 292

with cancer. RNs can gain the required knowledge to function as a competent oncology nurse in 293

many different ways. 294

Most education provided to RNs new to oncology is done as part of orientation to a new 295

position. They may participate in a structured program, such as a residency or fellowship, or 296

more informally through engagement in educational and skills attainment programs offered by 297

healthcare, professional or other organizations. No matter the source of oncology content, it is 298

incumbent on the employing organization to provide these nurses with opportunities to practice 299

and demonstrate competence in the skills required for safe and quality oncology patient care. 300

Graduate-Level Prepared Registered Nurses 301

Many opportunities exist in cancer care for nurses who wish to advance their career through 302

pursuit of additional academic education. These roles fall into two categories: Advanced Practice 303

Registered Nurse (APRN) and non-APRN roles. APRNs in oncology function as nurse 304

practitioners or clinical nurse specialists. Non-APRN roles vary greatly, but most commonly 305

focus on administration, clinical or academic education or nursing research. In addition, many 306

oncology nurses who earn graduate degrees will transition to a leadership role in their sub-307

specialty area, providing mentoring and guidance. All graduate-level prepared nurses have a 308

responsibility to function at the full scope of their license, using their expertise and education to 309

advance the science of nursing. 310

Educational preparation – non-APRN roles: 311

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All graduate-level prepared RNs in oncology must have a masters or doctorate degree in 312

nursing and an active RN license. The need for oncology-specific content and skills will vary 313

based upon the RN’s experience prior to entering graduate school as well as whether the program 314

completed included an oncology focus or opportunities to attain oncology knowledge and skills. 315

For graduate-level prepared RNs who do not have oncology experience or an opportunity to 316

acquire oncology specific knowledge and skills, it is essential that they pursue opportunities to 317

gain these through education or training programs designed for RNs in their specific role. In 318

addition, the employing organization must evaluate these graduate-level prepared RNs for 319

competence in the skills required for safe and quality oncology patient care and support their 320

efforts to attain these competencies. 321

Educational preparation – Oncology APRN roles: 322

Oncology APRNs must have completed an accredited APRN program (masters or doctorate 323

level) and have an active APRN license in the state where they practice. The need for oncology-324

specific content and skills will vary based upon the APRNs experience prior to entering graduate 325

school as well as whether the program completed included an oncology focus or opportunities to 326

attain oncology knowledge and skills. The APRN who does not have prior oncology experience 327

or whose academic program did not provide the opportunity to acquire essential oncology 328

knowledge and skills must pursue educational or training programs designed for the oncology 329

APRN. In addition, the employing organization must evaluate these APRNs for competence in 330

the skills required for safe and quality oncology patient care and support their efforts to attain 331

these competencies. 332

Continuing Professional Development 333

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Healthcare is ever evolving with new science and innovations in patient management 334

discovered on a nearly daily basis. As reflected in the historical perspective on oncology nursing 335

and current trends, cancer care is rapidly evolving as researchers and clinicians learn more about 336

the genetic basis of cancer and develop new therapies that provide exciting improvements in 337

disease outcome and symptom management. However, the frequency with which new 338

approaches are approved, the complexity of new treatment regimens, the unique side effects 339

caused by novel therapies and the volume of information and skills that oncology nurses must 340

master can be overwhelming and challenging to keep pace with. Oncology RNs must continually 341

learn and evolve their practice to ensure the safety and quality of life of their patients. 342

Each oncology nurse has the responsibility to maintain professional competence to ensure 343

that the highest quality care based on the best current evidence is provided to people with cancer. 344

It is essential that each nurse assess his/her needs and identify methods by which to decrease 345

gaps in knowledge, skill or practice (ANA position statement on professional role competence). 346

The Oncology Nursing Scope and Standards of Practice sets minimal standards for the practice 347

of oncology nursing and provides competencies that individual oncology nurses should use to 348

evaluate their practice and identify gaps and areas for growth. It is the personal professional 349

responsibility of the oncology nurse to seek the education and experience needed to fill the 350

identified gaps. 351

The mission of ONS is “to advance excellence in oncology nursing and quality cancer care” 352

(ONS, 2016a). This mission is supported by core values and strategic initiatives that seek to 353

disseminate current evidence to guide practice, expand oncology nursing educational 354

opportunities, facilitate integration of oncology content into more diverse venues, and help 355

nurses integrate new knowledge into practice. Providing education and evidence-based resources 356

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to nurses who care for people with cancer is one of the priorities of the Oncology Nursing 357

Society. In addition, oncology RNs who are certified by the Oncology Nursing Certification 358

Corporation (ONCC) are required to complete a self- assessment then are directed to educational 359

opportunities to close identified gaps. Through these avenues, ONS carries out its mission by 360

supporting the process of lifelong learning. 361

Oncology Specialty Practice Certification 362

One way that nurses who specialize in cancer care can engage in lifelong learning and 363

demonstrate their ongoing competence is through achievement of oncology nursing certification. 364

The Oncology Nursing Certification Corporation (ONCC), an affiliate of the Oncology Nursing 365

Society (ONS), has been offering oncology nursing specialty certifications since 1986. 366

Accredited by the National Commission for Certifying Agencies (NCCA), ONCC currently 367

offers 5 oncology nursing certifications (Oncology Certified Nurse (OCN), Advanced Oncology 368

Certified Nurse Practitioner (AOCNP), Certified Pediatric Hematology Oncology Nurse 369

(CPHON), Certified Breast Care Nurse (CBCN), Bone and Marrow Transplant Certified Nurse 370

(BMTCN). In addition, 3 previously offered certifications may be renewed through professional 371

development (Advanced Oncology Certified Clinical Nurse Specialist (AOCNS), Advanced 372

Oncology Certified Nursing (AOCN), Certified Pediatric Oncology Nursing (CPON)). The 373

mission of ONCC is to “promote health and safety by validating competence and ensuring life-374

long learning in oncology nursing and related specialties”. (ONCC website) Each certification is 375

based upon a rigorous process to ensure that it reflects current oncology nursing practice and 376

adheres to NCCA Standards for the Accreditation of Certification Programs (NCCA website). 377

Certification in recognized in the oncology community as an indicator that an RN has the 378

knowledge needed to competently provide quality cancer care to the people they care for in their 379

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specialty or subspecialty area. Certification in oncology nursing may also be used by employers 380

to meet accreditation or other recognition standards by such organizations as Joint Commission 381

on Accreditation of Healthcare Organizations, American Nurses Credentialing Center’s Magnet 382

Recognition Program™, the Association of Community Cancer Centers and the American 383

College of Radiation Oncology. 384

In addition to certifications, ONS and ONCC offer certificates of additional qualification 385

programs for experienced nurses who administer antineoplastic drug therapy and for nurses who 386

specialize in radiation oncology. These programs provide in-depth educational programs 387

followed by a comprehensive exam designed to document the knowledge needed to care for 388

people receiving these complex therapies. 389

Initial achievement and renewal of these certifications and certificates of additional 390

qualification provides the oncology RN with an opportunity to evaluate their current knowledge 391

and identify areas for continuing professional development. In addition, holding one of the 392

oncology certifications or certificates is recognized by many employers as evidence of 393

competence in the practice of oncology nursing. 394

Ethics 395

A cancer diagnosis directly impacts an individual’s quality of life, leading to distress and 396

feelings of vulnerability and powerlessness. This can compromise their ability to fully participate 397

in difficult conversations and make complex decisions. Oncology nurses are in a unique position 398

to help prevent and identify ethical issues and work with people with cancer and their caregivers 399

to determine their goals, needs and values. The oncology nurse must advocate to ensure that 400

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decisions made about the patient’s health care support their right to self-determination 401

(Iseminger, Buratto and Storey, 2016). 402

Provision 1: The nurse practices with compassion and respect for the inherent 403

dignity, worth, and unique attributes of every person. 404

The oncology nurse takes time and effort to assess the patient’s values including but not 405

limited to cultural, spiritual, generational, as they relate to the diagnosis and options for 406

treatment and care. Fostering non-judgmental dialogue and advocating for patient rights are 407

essential for the oncology nurse to demonstrate appropriate ethical conduct. The oncology nurse 408

promotes and upholds the patient’s right to self-determination. 409

Provision 2: The nurse’s primary commitment is to the patient, whether an 410

individual, family group, community, or population. 411

The oncology nurse is mindful of actual and potential ethical dilemmas and advocates for 412

discussions and decisions that support ethical care that reflects the goals, needs and values of 413

individual patients and their caregivers. By fostering a non-judgmental environment all parties 414

are represented and the goal for primary commitment to patient is recognized and supported. 415

Provision 3: The nurse promotes, advocates for, and protects the rights, 416

health, and safety of the patient. 417

At all points on the continuum of care the oncology nurse responds to ethical issues by 418

mobilizing organizational resources that address ethical dilemmas. Key areas of concern include 419

end of life care, informed consent for tests and treatment, patient confidentiality, and decision 420

making related to risks and benefits of cancer treatment. The oncology nurse knows how to 421

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address veracity, beneficence, non-maleficence, autonomy, justice, and fidelity during 422

discussions with patients, colleagues and agencies participating in care and decisions related to 423

actual or potential cancer diagnosis. 424

Provision 4: The nurse has authority, accountability, and responsibility for 425

nursing practice; makes decisions; and takes action consistent with the 426

obligation to promote health and to provide optimal care. 427

The oncology nurse takes responsibility for the quality and effectiveness of care with 428

consideration of the individual’s right to choose while promoting practices and decisions that 429

support or result in optimal health and well-being. There are times when people facing cancer 430

make decisions or engage in practices that pose potential risk, harm, or threaten effectiveness of 431

treatment. For example, some patients continue to smoke while receiving therapy for cancers 432

with a known link to tobacco use. While the oncology nurse expresses respect for the patient’s 433

right to self-determination, the nurse also provides counseling about smoking cessation options 434

and provides referrals as appropriate. 435

Provision 5: The nurse owes the same duties to self as to others, including the 436

responsibility to promote health and safety, preserve wholeness of character 437

and integrity, maintain competence, and continue personal and professional 438

growth. 439

Oncology nurses develop and maintain self-worth and dignity through collegial exchange of 440

information, certification and credentialing. Ongoing competency development and maintenance 441

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is essential in the field of cancer care where technology and treatments are advancing at rapid 442

rates. 443

Provision 6: The nurse, through individual and collective effort, establishes, 444

maintains, and improves the ethical environment of the work setting and 445

conditions of employment that are conducive to safe, quality health care. 446

Through education and professional growth activities, the oncology nurse establishes, 447

maintains, and improves the ethical environment for self and colleagues. Attention is given to 448

cancer specific practices of hazardous drug safe handling, exposure to radioactive sources, 449

potential conflict of interest with commercial and pharmaceutical companies, and prudent 450

prescription of pharmaceutical analgesic agents. 451

Provision 7: The nurse, in all roles and settings, advances the profession 452

through research and scholarly inquiry, professional standards development, 453

and generation of both nursing and health policy. 454

Oncology nurses are active participants in research projects and application of findings to 455

cancer prevention, diagnosis, treatment and symptom management and adhere to highest 456

standards of scientific, legal, moral and ethical conduct. Opportunities for participation in 457

developing standards and supporting these roles are available at organizational, local, regional, 458

national and international levels. 459

Provision 8: The nurse collaborates with other health professionals and the 460

public to protect human rights, promote health diplomacy, and reduce health 461

disparities. 462

22

Cancer care can be expensive and for those with inadequate or no health insurance may have 463

limited access to prevention, screening and early detection services. This can lead to inadequate 464

or delayed treatment and increased mortality (ONS, 2016b). Establishing open communication 465

and ensuring representation when policies related to cancer care are being developed allows 466

oncology nurses to ensure that decisions are made that protect human rights, promotes health 467

diplomacy and reduces health disparities. 468

Provision 9: The profession of nursing, collectively through its professional 469

organizations, must articulate nursing values, maintain the integrity of the 470

profession, and integrate principles of social justice into nursing and health 471

policy. 472

Adhering to legal, organizational and professional standard of care allows the oncology nurse 473

to collaborate with internal and external sources for optimum outcome when ethical issues arise 474

or discussions, actions or decisions are in question. The oncology nurse is integral in bridging the 475

clinical aspects of patient needs/care with proposed policy to ensure that decisions accurately and 476

fairly represent those with cancer. Oncology nurses utilize standards of care and the strongest 477

available evidence to provide the highest quality care and maintain the integrity of clinical 478

practice. Membership in professional organizations e.g. Oncology Nursing Society, International 479

Society of Nurses in Cancer Care provide a forum for collegial exchange of ideas, information 480

and resources based on sound scientific evidence. 481

Trends in Oncology 482

23

2016 saw rapid improvements in the care of patients with cancer, reflected in declining 483

incidence and mortality rates for many cancers, and in unprecedented advances in drugs and 484

technology. Prevention activities by the oncology nurse, such as education about early screening, 485

tobacco cessation support, and lifestyle educational efforts, have contributed to improved 486

mortality rates. Despite these trends, challenges remain in healthcare, and in specific within 487

oncology settings. 488

Access to care/affordability of care 489

As Americans are living longer, and as mortality declines, more people are living as 490

survivors in need of ongoing access to oncology care. This increased need translates to increased 491

stress on current providers, and an increasing demand for specialized nurses functioning both as 492

generalists and as advanced practice providers. 493

Disparities in care remain a significant challenge. Causes include health insurance 494

availability and affordability, increased drug pricing, and ongoing socioeconomic disparities in 495

race, ethnicity and geographical access, associated with delayed time to treatment, increased side 496

effect profiles, and increased costs (ASCO, 2017). About one in every three working-age 497

survivors of cancer have debt that is associated with their cancer care, and 55% of these have 498

incurred debt of $10,000 or more (ASCO, 2017). Although changes in recent years has afforded 499

some protections against lifetime spending limits or pre-existing condition clauses for some of 500

the insured, those without insurance continue to demonstrate poorer health outcomes than those 501

who are insured (ASCO, 2017). Although there are increasingly options for treatment for people 502

with cancer, escalating drug prices for novel oncology targets contribute to debilitating financial 503

toxicity for those whose insurance requires significant copayment, or for the uninsured or on 504

Medicare. 505

24

Changes to insurance environment 506

Recent evidence supports that patients with cancer have had greater access to healthcare 507

insurance, with the associated improvement in health outcomes. For example, there was an 8% 508

increase in early colorectal cancer diagnoses between 2011 and 2013, after screening for the 509

disease was available without a copay charge through Medicare (ASCO, 2017). The instability of 510

the healthcare market, however, and potential changes in the Affordable Care Act can create 511

instability for patients who would otherwise be unable to afford care without insurance coverage, 512

or could not pay deductible, co-pay and “donut hole” fees in order to receive life-sustaining care. 513

This, coupled with the escalating costs of drug development, puts this patient population at risk 514

for financial burden, and in some cases, bankruptcy 515

Aging population/comorbidities 516

The demand for oncology nurses will continue to rise exponentially, as the American 517

population continues to grow and to age. Although some commonly diagnosed cancers have 518

declined in incidence, others have increased, requiring a need for a broad knowledge base in 519

cancer care. As the number of survivors increases annually, so do the long-term care needs, 520

concurrent comorbidity management, and increased complexity of this population, requiring a 521

highly skilled workforce for effect monitoring and care. Care coordination is increasingly critical 522

to assure that comprehensive care from multiple specialty providers is received. Oncology nurses 523

fulfill this critical role in multiple care settings, to assure that holistic patient needs are addressed 524

through the care continuum (ASCO, 2017). 525

Opioid epidemic and oncology care needs 526

25

Although primary care provides about half of the opioid prescriptions in the U.S. (CDC, 527

2017), oncology care relies heavily on opioid pain management. Despite undeniable misuse and 528

its associated consequences in the U.S., the need for access to opioids for unique pain syndromes 529

associated with cancer persists. Oncology nurses must be skilled at identification of true 530

substance misuse versus dependency, as well as complex pain symptom control, to assure 531

effective care of the oncology patient population. People with cancer, and those at end of life are 532

at risk for unrecognized pain and inadequate pain management (Dowell, Haegerich, & Chou, 533

2016). The oncology nurse’s knowledge of pain physiology, pharmacologic and non-534

pharmacologic interventions, abuse screening, and complex symptom control is crucial to 535

effective pain management and to abuse deterrence. Oncology nurse leadership through a deep 536

understanding of pain physiology and symptom control, and through effective patient education 537

and support, is crucial to assuring that patients with cancer receive adequate pain control while 538

avoiding abuse (National Academy of Medicine, 2017). 539

Precision medicine/immunotherapy 540

Perhaps the most rapidly changing area in oncology practice is the substantial advances in 541

biologic anti-cancer agents. Called ‘precision medicine’ due to the identification of molecular 542

targets that can be matched to specific tumor characteristics, many patients now truly receive 543

individualized treatment planning that is more likely to benefit them, based on precise molecular 544

diagnostics. Testing has advanced from discrete gene mutation testing of tumor tissue to next-545

generation sequencing diagnostics that can test for dozens of mutations, amplifications, or gene 546

rearrangements from a single sample. Testing can now be accomplished for some mutations 547

using urine or blood samples, when tissue is unavailable. These advancements translate to 548

26

meaningful overall survival outcomes for many patients, can predict prognosis, and can identify 549

drug resistance. 550

Quality metrics (MACRA) and new payment systems 551

The shift from fee for service to pay for performance in healthcare systems is driven by 552

quality metric monitoring; healthcare providers, both individuals and organizations, will be 553

rewarded based on patient care outcomes and improved patient engagement (CMS, 2017). 554

Oncology nurses are key contributors to effective value management systems through 555

performance and analysis of quality measures that are nursing sensitive. Advanced practice 556

providers (APRNs) must demonstrate their contribution to quality metrics for reimbursement; 557

however, organizational payment is also dependent on nursing sensitive measures that will 558

ultimately drive both costs and reimbursement. The oncology nurse must be prepared to address 559

and act on quality metrics focused on assessment and treatment aims that demonstrate improved 560

outcomes. 561

New sources of data/Access and knowledge 562

Process changes and new coalitions have elevated access to data, and ultimately access for 563

patients to emerging therapeutics. The FDA’s Oncology Center for Excellence integrates and 564

accelerates the regulation of new oncology products; the National Institute of Health and its 565

foundation partnered with biopharmaceutical and research companies to created the Partnership 566

for Accelerating Cancer Therapies (PACT), to fund pre-competitive research, thereby making 567

way for data to be much more broadly available among competitive parties for future research. 568

The National Cancer Institute has prioritized patient education and access to clinical trials 569

information and involvement. The 21st Century Cures Act (H.R.34) of 2016 appropriated 570

27

millions in supplemental funding to support the Cancer Moonshot Initiative, a commitment to 571

supporting critical cancer research, improving electronic medical record function and the 572

advancement of big data availability, enhancing clinical trials availability information, and 573

supporting centralized institution review boards and data standardization. These efforts enhance 574

and support research and result in an ever-escalating volume of data sources and new knowledge 575

(ASCO, 2017). 576

Trends in Oncology Nursing 577

Essential oncology competencies 578

Effective oncology nurses must prepare for a lifelong learning environment, as the 579

expectations for advanced care delivery will only increase as oncology care continues to advance 580

(NCSBN, 2017). Because of the integration of patients with cancer in nearly every care setting, 581

and because of the vastly increasing numbers of oncology survivors, essential oncology 582

competencies are critical to safe and effective nursing care delivery by any RN who practices in 583

any care setting. Successful validation of these essential competencies at the undergraduate level 584

is key to assuring that all patients who have or have had cancer, in whatever setting they present, 585

receive consistent and safe care. 586

Expanding use of technologies 587

The explosion of computer-assisted healthcare by the public for information searches, access 588

to healthcare portals, as assistive personnel during healthcare encounters has elevated 589

expectations for immediate access to health information. Nurse knowledge and acumen in use of 590

28

these technologies has expanded to include integration of electronic health records, treatment 591

algorithms, reference texts and other resources via electronic formats. 592

The rapid advancement of electronic delivery and storage of healthcare information improves 593

decision-making and care planning at the bedside, and allows inclusion of the patient and family 594

as part of the care team. Computerized clinical pathways and guidelines, computer-generated 595

order sets, and dose-checking algorithms have contributed to more standardized cancer care and 596

have minimized errors (Shulmeister, 2016). Technology allows remote access to patients where 597

once they would have had to travel to access provider care; likewise, remote availability of 598

providers encourages more collaborative decision-making and provides access to trained 599

professionals to very rural areas. 600

Advances such as real-time communication technology, bar coding and scanning of 601

medication, use of smart pumps with integrated drug libraries and safety parameters are 602

commonly available in oncology settings, requiring advanced knowledge and training for 603

effective use. Education kiosks and self-paced education modules have changed the modalities 604

used by nurses for education of patients and validation of their understanding (Shulmeister, 605

2016). As shifts toward technology-assisted traditional nursing tasks increase, the demand for 606

highly technically skilled nurses will persist for complex patient populations, such as oncology 607

patients (NCSBN, 2017). 608

Challenges for oncology nurses include limitations in non-oncology specific electronic health 609

records (EHRs) that may compromise essential documentation. Nurses must proactively educate 610

patients regarding how to find and interpret reliable data on the Internet, and are increasingly 611

called upon by patients to interpret these data (Shulmeister, 2016). Finally, competent use of 612

29

complex technologies in cancer care requires advanced skill in communication, technical 613

expertise, data analysis, and data security (NCSBN, 2017). 614

Evidence based translational practice 615

Oncology nurses lead the field in evidence-based, patient-centered and highly skilled care 616

delivery. Oncology nurses heavily rely on evidence to inform treatment and management 617

decision-making, especially as new therapies and evidence of their effectiveness emerge. 618

Oncology nurses must incorporate interpretation of scientific evidence into translational 619

behaviors to affect clinical practice and quality measurement. The complexity of both old and 620

new therapeutic protocols, the emergence of new oncologic emergencies, and the physiologic 621

differences inherent in the management of patients receiving emerging therapies requires rapid 622

incorporation of new clinical knowledge to assure safe and quality directed care. Advances in 623

oncology include all areas of patient care, such as prevention, detection, pharmacology, symptom 624

management, and skilled care delivery. Oncology nurses must possess essential competencies in 625

multiple specialty realms, including palliative care, genetics and genomics, critical care, and end 626

of life care. A commitment to ongoing education and evaluation of emerging evidence is 627

inherent in oncology nursing practice. 628

629

30

Standards of Oncology Nursing Practice 630

Professional practice standards are “authoritative statements of the duties that all registered 631

nurses, regardless of role, population, or specialty, are expected to perform competently” (ANA, 632

2015, p. 51). These standards outline expectations of nursing practice across settings and provide 633

practice guidelines for institutions and individual nurses practicing in specialties such as 634

oncology. Current, evidence-based, nationally recognized standards for the practice of oncology 635

nursing are critical to the future of oncology nursing practice. 636

Oncology Nursing: Scope and Standards of Practice delineates the professional 637

responsibilities of nurses engaged in cancer practice regardless of care setting or specific 638

position. These standards of practice include standards of practice, which reflect the nursing 639

process, and standards of professional practice, which describe professional responsibilities of 640

oncology nurses. For each standard, a listing of competencies is provided which can be used to 641

demonstrate compliance with the standard. 642

Standards of Practice Standards of Professional Performance

Assessment Ethics

Diagnosis Culturally Congruent Care

Outcomes Identification Communication

Planning Collaboration

Implementation Leadership

Coordination of Care Education

Health Teaching and Health Promotion Evidence-Based Practice and Research

Evaluation Quality of Practice

Professional Practice Evaluation

Resource Utilization

Environmental Health

643

31

You will note that for each standard there are 2-3 levels of competencies listed. The RN 644

competencies apply to all oncology RNs. The graduate-level prepared RN competencies assume 645

competency in the RN level competencies while adding additional requirements for nurses with 646

an advanced degree (APRN and non-APRN). In addition, the advanced practice registered nurse 647

(APRN) competencies highlight responsibilities specific to the APRN in additional the RN and 648

graduate-level prepared RN competencies. 649

Standards of Practice 650

Standard 1. Assessment 651

Description 652

The oncology nurse systematically and continually collects data regarding the physical, 653

genetic, psychological, social, spiritual, and cultural health status of the patient, including in-654

depth data specific to the disease and treatment experience of the patient with cancer. 655

Competencies 656

The oncology registered nurse: 657

1.1 Collects pertinent data, including but not limited to: demographics; social determinants of 658

health, health disparities, family, genetic, disease and treatment history; physical, functional, 659

psychosocial, emotional, cognitive, sexual, cultural, age-related, environmental, 660

spiritual/transpersonal, and economic assessments. These are conducted in a systematic, ongoing 661

process with compassion and respect for the inherent dignity, worth, and unique attributes of 662

every person. 663

32

1.2 Utilizes data collected from multiple sources, including the patient, caregivers, other 664

health care providers, and the community, to identify potential or actual problems and barriers to 665

care. 666

1.3 Collects assessment data at each care transition across the cancer care continuum and 667

modifies care plan to address changes. 668

1.4 Uses theoretical and evidence-based concepts in nursing to assess individual patient 669

populations. 670

1.5 Uses appropriate evidence-based assessment techniques, instruments and technologies in 671

collecting data, including valid and reliable instruments designed for the oncology population. 672

1.6 Elicits the patient's values, preferences, needs, and knowledge of the healthcare situation 673

as it relates to their potential or actual cancer diagnosis. 674

1.7 Identifies barriers to effective communication based on physical limitations, 675

psychosocial, literacy, financial, and cultural considerations. 676

1.8 Documents initial and ongoing assessment data clearly and concisely in a retrievable 677

form to facilitate interprofessional communication and continuity of care. 678

Additional competencies for the graduate-level prepared registered nurse 679

In addition to the registered nurse competencies, the graduate-level prepared registered nurse 680

and the advanced practice registered nurse: 681

1.9 Assesses the supportive and deliterious effects of interactions among individuals, 682

caregivers, community, and social systems on people at risk for or diagnosed with cancer 683

throughout the cancer care continuum. 684

1.10 Assists the RN in the development and maintenance of evidence-based assessment skills 685

with a focus on common cancer-related problem areas. 686

33

Additional competencies for the advanced practice registered nurse 687

In addition to the competencies of the registered nurse and the graduate-level prepared 688

registered nurse, the advanced practice registered nurse: 689

1.11 The APN performs a health history review of systems and a comprehensive physical 690

examination. 691

1.12 Orders or recommends relevant diagnostic tests, procedures, genetic counseling/testing, 692

and other assessment methods, including tests that are specific to the diagnosis, assessment, 693

and/ or monitoring of patients undergoing active cancer treatment. 694

1.13 Synthesizes and integrates findings to develop a comprehensive patient and family 695

record and problem list. 696

1.14 Communicates and collaborates with the interprofessional team regarding clinical 697

findings and contributes to the plan of care. 698

699

700

34

Standard 2. Diagnosis 701

Description 702

The oncology nurse analyzes assessment data to determine actual or potential diagnoses, 703

problems, and issues related to cancer and non-cancer health concerns of patients. 704

Competencies 705


2.1 Determines cancer-related nursing diagnoses and potential problem statements derived 707

from assessment data and knowledge about cancer, the cancer care continuum and usual patient 708

care needs. 709

2.2. Develops individualized nursing diagnoses that are physically, psychologically, socially, 710

spiritually, and culturally appropriate to the patient with cancer. 711

2.3 Reviews nursing diagnoses with the patient, caregiver(s), and interprofessional cancer 712

care team. 713

2.4 Prioritizes nursing diagnoses according to actual or potential threats to the patient's 714

wellbeing and goals established with the patient and caregiver(s). 715

2.5 Documents nursing diagnoses in a retrievable form available to the interprofessional team 716

to facilitate identification of desired patient outcomes and continuity of care. 717




2.6 Assists nursing staff in development and maintenance of competency in the development 721

of nursing diagnoses. 722

35




2.7 1 Systematically formulates differential diagnoses and identifies problems by comparing 726

and contrasting clinical and research data. 727

2.8 Prioritizes diagnoses, problems, and risk estimation with regard to physical, 728

psychological, social, spiritual, and cultural concerns. 729

2.9 Documents diagnoses, problems, and risk estimation clearly to facilitate identification 730

and initiation of the treatment plan and outcome evaluation. 731

2.10 Collaborates with the interdisciplinary cancer care team to ensure comprehensive 732

differential diagnoses and problem identification. 733

2.11 Documents diagnoses, problems, and risk estimation clearly to facilitate identification 734

and initiation of the treatment plan and outcome evaluation. 735

736

36

Standard 3. Outcomes Identification 737

Description 738

The oncology nurse identifies expected outcomes individualized to the patient and caregiver 739

with a focus on health promotion and maintenance, restoration, rehabilitation, or a peaceful and 740

comfortable death. 741

Competencies 742


3.1. Identifies expected outcomes to maximize the patient’s functional abilities with careful 744

consideration of risks, benefits, costs, current evidence-based practice, and clinical knowledge. 745

3.2 Develops expected outcomes collaboratively with the patient, family, and 746

interprofessional cancer care team. 747

3.3 Ensures that expected outcomes are physically, psychologically, socially, spiritually, and 748

culturally realistic and appropriate for the patient regardless of position on the cancer care 749

continuum. 750

3.4 Ensures that expected outcomes are used to provide direction for continuity of care. 751

3.5 Periodically reevaluates progress towards outcomes and aligns expected outcomes 752

accordingly. 753

3.6 Documents expected outcomes as measurable goals derived from current evidence in a 754

retrievable form available to the interprofessional team to facilitate continuity of care. 755




37

3.7 Assists staff in development and maintenance of outcome planning skills. 759




3.8 Selects, formulates and integrates a wide array of measurable outcomes to provide a 763

balanced and comprehensive view of healthcare delivery. 764

3.9 Collaborates with the interprofessional team to develop outcomes with the recognition of 765

associated risks, benefits, and costs to the patient and family. 766

3.10 Modifies expected outcomes in response to changes in healthcare status of the patient 767

and identify priorities regarding continuity of care and long-term planning. 768

769

38

Standard 4. Planning 770

Description 771

The oncology nurse develops an individualized and holistic plan of care that prescribes 772

interventions to attain expected outcomes. 773

Competencies 774


4.1 Develops a plan of care based on knowledge of oncology nursing, evidence-based 776

research, economic impact and biologic, sociocultural, behavioral, and physical sciences and 777

knowledge of cancer and the cancer care continuum. 778

4.2 Supports a plan of care that is patient centered, outcome oriented, and based on 779

individualized nursing diagnoses. 780

4.3 Incorporates appropriate preventive, therapeutic, rehabilitative, and palliative nursing 781

interventions into the plan of care at each phase of the cancer care continuum. 782

4.4 Identifies community resources and support systems needed to address barriers that may 783

interfere with successful implementation of the plan of care. 784

4.5 Supports a plan of care that reflects sensitivity and respect for the patient’s religious, 785

spiritual, social, cultural, and ethnic beliefs and practices. 786

4.6 Prioritizes elements of the plan based on the patient’s goals, needs and preferences. 787

4.7 Develops the plan of care in collaboration with the patient, caregiver and 788

interprofessional cancer care team. 789

4.8 Coordinates resources and consultative services to provide continuity of care and follow-790

up to the plan of care. 791

39

4.9 Communicates the plan of care to other members of the interprofessional cancer care 792

team and documents the plan of care in a retrievable form available to the interprofessional team 793

to facilitate continuity of care. 794

4.10 Modifies the care plan according to the ongoing assessment of the patient's response to 795

interventions and progress toward expected outcomes. 796




4.11 Assists staff in the development and maintenance of care planning skills. 800

4.12 Actively participates in the development and continuous improvement of systems that 801

support the planning process. 802




4.13 Uses data to collaborate with interprofessional team to develop a plan of care for people 806

at risk for or with a diagnosis of cancer based on identified problems, expected outcomes, and 807

the patient's goals, needs, and values. 808

4.14 Ensures the plan of care reflects current clinical practice guidelines and is grounded in 809

evidence. 810

4.15 Alters plan of care as patient moves through continuum of care. 811

812

40

Standard 5. Implementation 813

Description 814

The oncology nurse implements the plan of care to achieve the expected outcomes for the 815

patient. 816

Competencies 817


5.1 Implements interventions according to the established plan of care in collaboration with 819

the patient and caregiver. 820

5.2 Ensures that interventions are implemented in a safe, culturally congruent, caring, and 821

humanistic manner. 822

5.3 Uses current evidence to guide implementation of interventions to achieve the mutually 823

identified expected outcomes. 824

5.4 Leverages current and emerging technology to implement the care plan, enhance nursing 825

practice and improve patient outcomes. 826

5.5 Uses critical thinking to closely monitor patient response to interventions and modifies 827

strategies when changes to patient status occur. 828

5.6 Facilitates access to community resources and support systems needed to implement the 829

plan of care. 830

5.7 Documents interventions, the patient’s responses and any modifications to the plan in a 831



41



5.8 Promotes staff development and maintenance of skills for care plan implementation. 836




5.9 Prescribes or recommends evidence-based pharmacological agents and treatments 840

according to clinical indicators and results of diagnostic and laboratory tests. 841

5.10 Provides clinical consultation to healthcare professionals, patients and caregivers related 842

to cancer related issues to improve care and patient outcomes. 843

5.11 Applies oncology specific clinical expertise when ordering, conducting and interpreting 844

diagnostic tests and procedures to monitor and diagnose manifestations of cancer and its 845

treatment. 846

5.12 Facilitates access to programs and services when implement ing and integrating the plan 847

of care. 848

5.13 Collaborates with the patient and family in the implementation of care to promote 849

autonomy and self-determination based upon available resources. 850

42

Standard 5A. Coordination of Care 851

Description 852

The oncology RN ensures that care is coordinated during episode of care and transitions in 853

care. 854

Competencies 855


5A.1 Coordinates implementation of the care plan with attention to patient and caregiver 857

goals, needs and preferences, resource availability, accessibility, quality, and financial 858

considerations. 859

5A.2 Assesses for potential or actual barriers to effective implementation of the care plan and 860

the expected treatment plan based upon knowledge of cancer, standards of care and point on the 861

cancer care continuum. 862

5A.3 Facilitates communication among the interprofessional cancer care team, patient and 863

caregiver to effect smooth transitions between internal and external care settings. 864

5A.4 Facilitates referrals to health care providers or resources to promote, maintain, or 865

restore health are made to facilitate continuity in care. 866

5A.5 Documents steps taken to ensure continuity of care in a retrievable form available to the 867

interprofessional team to facilitate continuity of care. 868




5A.6 Facilitates staff development and maintenance of care coordination skills. 872

43




5A.7 Provides leadership in the coordination of interprofessional cancer care for integrated 876

delivery of cancer care services to achieve safe, effective, efficient, timely, patient-centered, and 877

equitable care (IOM, 2010). 878

5A.8 Makes referrals to health care providers or resources to promote, maintain, or restore 879

health are made to facilitate continuity in care. 880

5A.9 Synthesizes comprehensive assessment data to match patient and caregivers(s) needs 881

with available resources throughout the continuum of care. 882

883

44

Standard 5B. Health Teaching and Health Promotion 884

Description 885

The oncology RN employs strategies to empower patients and promote health, safety and 886

quality care. 887

Competencies 888


5B. 1Assesses the patient and caregiver(s) for risks, current health beliefs and practices, 890

readiness to learn, and educational needs related to potential or actual cancer diagnosis. 891

5B.2 Develops a patient education plan to address patient and caregiver learning needs 892

associated with their potential or actual cancer diagnosis, values, beliefs, health practices, 893

developmental level, readiness and ability to learn, communication barriers including language 894

preference, spirituality, culture, and socioeconomic status. 895

5B.3 Collaborates with interprofessional cancer care team to ensure that the education plan is 896

holistic and provides the interventions and resources most likely to maintain or improve quality 897

of life. 898

5B.4 Identifies, validates, and uses evidence-based resources and appropriate technologies to 899

support the goals of the patient education plan. 900

5B.5 Provides healthcare consumers with information about intended effects and potential 901

adverse effects of the plan of care. 902

5B.6 Documents education plan and health teaching completed clearly and concisely in a 903



45



5B.7 Identifies recurrent problems and healthcare system deficiencies. Additional 908

competencies for the advanced practice registered nurse 909




5B.8 Participates in evidence-based educational strategies and the development of research 913

ideas and proposals focused on the manifestations of cancer and its treatment. 914

5B.9 Leads the development and dissemination of cancer-related patient education resources. 915

5B.10 Assists staff in the development and maintenance of patient and caregiver(s) education 916

and health promotion skills. 917

918

46

Standard 6. Evaluation 919

Description 920

The oncology nurse systematically and regularly evaluates the patient’s response to 921

interventions and revises the nursing care plan to determine progress toward achievement of 922

expected outcomes. 923

Competencies 924


6.1 Participates as part of an interprofessional, patient and caregiver collaborative process in 926

a ongoing evaluation of goals, needs, outcomes and values of the patient and caregiver(s). 927

6.2: Conducts ongoing and systematic analysis of the nursing process in collaboration with 928

the interprofessional team and patient/caregiver. 929

6.3: Compares actual to expected findings and uses data to revise care plan and 930

implementation strategies. 931

6.4 Provides timely and accurate documentation of evaluation findings and changes to plan in 932

a retrievable form accessible by all interprofessional team members. 933




6.5 Synthesizes evaluation results to identify recurrent healthcare problems, deficiencies, and 937

future educational and research needs related to cancer and its treatment. 938

6.6 Assists nursing staff in development and maintenance of evaluation skills. 939


47



6.7 Maintains a systematic and ongoing evaluation process of patient outcomes by collecting, 943

synthesizing and documenting data from all available sources. 944

6.8 Analyzes collected data in relationship to expected outcomes and collaborates with the 945

interdisciplinary cancer care team, patient and caregivers to implement and revise the care plan . 946

947

48

Standard 7. Ethics 948

Description 949

The oncology nurse uses ethical principles as a basis for decision making and patient 950

advocacy. 951

Competencies 952


7.1 Uses the Code of Ethics for Nurses with Interpretive Statements (ANA, 2001) as guiding 954

principles of professional practice. 955

7.2 Demonstrates ethical conduct when instructing and mentoring others, including students 956

and staff members. 957

7.3 Recognizes and evaluates personal beliefs and values that influence patient care 958

outcomes. 959

7.4 Values, understands, and incorporates ethical decision making into holistic care delivery 960

that recognizes and protects the patient’s individual rights, autonomy, confidentiality, values, 961

beliefs, preferences, needs, and dignity. 962

7.5 Applies knowledge of cancer genetics to evaluating legal, ethical, and social implications 963

of genetic and genomic technology and testing. 964

7.6 Identifies clinical practice situations that evoke professional moral distress and influence 965

nursing practice. 966

7.7 Responds to ethical concerns, issues, and dilemmas, enlisting available organizational 967

resources (e.g., ethics team or chaplain consultation) to aid in resolution of ethical dilemmas. 968

7.8 Establishes and maintains collegial interprofessional environment of open 969

communication to facilitate ethical discussions. 970

49

7.9 Advocates for and assists patients and caregivers in decision-making discussions and 971

healthcare team conferences to clarify goals of care including end of life and advance care 972

planning. 973

7.10 Prioritizes honoring patient wishes as documented in their advance directives or other 974

documents. 975

7.11 Advocates for ethical care of clinical trial and other research patients, especially as 976

related to informed consent. 977

7.12 Maintains and protects patient confidentiality and privacy according to federal, state and 978

institutional requirements 979

7.13 Communicates, and takes action if illegal, unethical, or unprofessional behaviors 980

threaten the safety, professional integrity, or quality of care in the clinical practice. 981







988

50

Standard 8. Culturally Congruent Care 989

Description 990

The oncology nurse practices in a manner that is congruent with cultural diversity and 991

inclusion principles. 992

Competencies 993


8.1 Practices culturally congruent care that is respectful, inclusive, and non-judgmental. 995

8.2 Engages in life-long learning to include cultural congruence education. 996

8.3 Acknowledges and accommodates patient and caregiver(s)' culturally congruent needs. 997

8.4 Uses skills and tools that are appropriately vetted for the culture, literacy, and language of 998

the population served. 999

8.5 Analyzes own behaviors for their culturally-specific interpretation. 1000

8.6 Supports patient and caregiver(s) in decision-making, regardless of cultural influences. 1001

8.7 Advocates for policies and practices culturally congruent care for all patients and 1002

caregiver(s). 1003

8.8 Educates and informs the interprofessional team about cultural congruence in care 1004

delivery. 1005




8.9 Advances organizational policies, programs, services, and practice that reflect respect, 1009

equity, and values for diversity and inclusion. 1010

51

8.10 Engages key stakeholders in designing and establishing internal and external cross-1011

cultural partnerships. 1012

8.11 Participates in the collection and utilization of evidence to advance culturally diverse 1013

healthcare initiatives. 1014

8.12 Develops recruitment and retention strategies to achieve a multicultural workforce. 1015

8.13 Leads interprofessional teams to identify and meet the cultural and language needs of 1016

the diverse oncology populations. 1017




8.14 Promotes shared decision-making solutions in planning, prescribing, and evaluating 1021

processes when the person at risk for or with a diagnosis of cancer cultural preferences and 1022

norms may create incompatibility with evidence-based practice. 1023

1024

1025

52

Standard 9. Communication 1026

Description 1027

The oncology nurse communicates effectively with the interprofessional cancer care team, 1028

the patient and their caregivers using strategies that foster mutual respect and shared decision-1029

making to enhance clinical outcomes and patient satisfaction. 1030

Competencies 1031


9.1 Examines personal communication style and skills to resolve conflict among the patient, 1033

family, and interprofessional team and seeks opportunities to improve communication skills as 1034

indicated. 1035

9.2 Identifies possible physical, psychological, developmental, cultural, and spiritual 1036

influences on effective communication among the interprofessional team, patient, and family. 1037

9.3 Assesses patient readiness, ability, and preferences, and adapts communication method to 1038

accommodate these. 1039

9.4 Assesses for barriers to effective communication, such as cultural or language barriers, or 1040

sensory, cognitive, or psychosocial barriers. Adapts communication method based on patient's 1041

needs. 1042

9.5 Prioritizes, reports and documents critical information using established communication 1043

methods 1044

9.6 Brings the nursing perspective to interactions with others and discussions with the 1045

interprofessional team. 1046


53



9.7 Assumes a leadership role in establishing or modifying environments that promote 1050

healthy communication. 1051

9.8 Assists nursing staff in development and maintenance of effective communication skills. 1052




9.9 Uses expertise in communication to help the interprofessional cancer care team to employ 1056

timely, sensitive and goal oriented strategies when dealing with challenging individuals and 1057

situations. 1058

54

Standard 10. Collaboration 1059

Description 1060

The oncology nurse partners with the patient and family, the interprofessional team, and 1061

community resources to optimize cancer care. 1062

Competencies 1063


10.1 Participates in interprofessional collaborations to foster open communication, mutual 1065

respect, team learning, shared decision making, and ongoing team development. 1066

10.2 Establishes expected outcomes in conjunction with colleagues, patients, and families 1067

and evaluates the effectiveness of interventions. 1068

10.3 Participates in assessment of learning needs and development and delivery of 1069

educational programs focused on cancer care issues and targeted to nursing and interprofessional 1070

learners. 1071

10.4 Collaborates with the interprofessional team to improve patient care processes to 1072

maximize safety, quality, communication and coordination of care. 1073

10.5 Coordinates care through collaborative practice and effective delegation to clinical team 1074

members to meet the healthcare needs of patients with cancer. 1075




10.6 Provides leadership for establishing, improving, and sustaining collaborative 1079

relationships to achieve safe, quality care 1080

55

10.7 Collaborates with and provides leadership to members of the interprofessional cancer 1081

care team in providing optimal care, including education, consultation, management, 1082

technological development, and research opportunities. 1083

1084

56

Standard 11. Leadership 1085

Description 1086

The oncology nurse leads in the practice setting and in the nursing profession by 1087

acknowledging the dynamic nature of cancer care and the necessity to prepare for evolving 1088

technologies, modalities of treatment, and supportive care. 1089

Competencies 1090


11.1 Assumes accountability for the delegation, coordination, and outcomes of care provided 1092

by others under direction of the RN 1093

11.2 Integrates evidence based science into practice 1094

11.3 Participates in peer and colleague mentorship, education, and advancement of oncology 1095

nursing practice. 1096

11.4 Identifies and advocates for vulnerable populations (e.g. elderly, very young, 1097

uninsured/under-insured, those with psychiatric conditions or with limited social support) 1098

11.5 Anticipates trends in cancer care and develops strategies to integrate new systems and 1099

technologies 1100

11.6 Documents outcomes of oncology nursing interventions and innovations. 1101

11.7 Demonstrates impact of specialty practice knowledge and skills on developing novel 1102

patient and family education programs and in recruiting and retaining oncology nurses. 1103

11.8 Participates in oncology professional organizations, boards, committees, and special 1104

interest groups (e.g., ONS, American Cancer Society, Leukemia and Lymphoma Society). 1105

11.9 Supports continuing professional development of self and colleagues. 1106

57




11.10 Promotes cost and quality discussions by translating and anticipating practice and 1110

patient learning requirements for new technologies. 1111

11.11 Disseminates evidence-based clinical practice, quality improvement and research 1112

findings through publications and presentations at professional meetings. 1113

11.12 Serves as an oncology nursing role model, preceptor, mentor, and educator for 1114

advanced oncology nursing and within the interprofessional team. 1115

11.13 Contributes to the identification of educational and research needs and to the 1116

development of creative and innovative practices for oncology nurses and oncology. 1117

11.14 Serves as a liaison about oncology and oncology nursing to institutional, professional 1118

and legislative bodies, at a local, state, and national level. 1119

11.15 Leads nursing staff in development of innovative nursing practices. 1120




11.16 Provides leadership to promote interprofessional teamwork for optimal outcomes for 1124

people with cancer. 1125

58

Standard 12. Education 1126

Description 1127

The oncology nurse seeks knowledge and competence that reflects the current state of cancer 1128

care and oncology nursing and promotes critical and futuristic thinking. 1129

Competencies 1130


12.1 Acquires and maintains knowledge and skills that support personal commitment to 1132

oncology nursing. 1133

12.2 Participates in lifelong learning to maintain expertise and experience related to oncology 1134

scientific, nursing and regulatory information. 1135

12.3 Uses academic and certification credentials to represent specific knowledge and skills. 1136

12.4 Focuses on quality outcomes measures to evaluate effectiveness of education (pre-1137

posttests, teach back practices). 1138

12.5 Identifies gaps in knowledge, skills and practice of self and others and pursues 1139

education and training to address unmet needs. 1140

12.6 Acquires knowledge and skills relative to the oncology nursing role, population, 1141

specialty, setting, and global or local health situation. 1142

12.7 Mentors and serves as role model for students and novice oncology nurses 1143




59

12.8 Consistently reviews and uses current evidence based information to expand advanced 1147

oncology nursing performance. 1148

12.9 Participates in lifelong learning in an effort to serve as a clinical expert and provide 1149

education to patients and other health care professionals. 1150

12.10 Maintains licensure and credentials consistent with advanced oncology nursing role 1151

and practice setting. 1152

12.11 Demonstrates proficiency in professional activities such as publications, presentations, 1153

performance improvement and research. 1154

1155

60

Standard 13. Evidence-Based Practice and Research 1156

Description 1157

The oncology nurse integrates evidence and research findings into practice while helping to 1158

identify and address gaps in current evidence. 1159

Competencies 1160


13.1 Articulates the values of research and its application relative to the healthcare setting 1162

and practice. 1163

13.2 Regularly accesses nationally recognized clinical practice guidelines to support 1164

evidence-based patient care. 1165

13.3 Bases clinical decision making and delivery of individualized patient care on best 1166

current evidence, patient values and preferences, and resource availability. 1167

13.4 In the absence of evidence, poses questions for further study and, supports/ participates 1168

in related research 1169

13.5 Facilitates integration of new evidence into standards of practice, development or 1170

modification of policies, practice guidelines, education, and clinical management strategies. 1171

13.6 Consistently contributes to the fullest extent of scope of practice, based on licensure and 1172

credentialing. 1173

13.7 Collaborates with the interprofessional cancer care team to ensure sound translation of 1174

research into clinical practice. 1175

13.8 Protects human subjects in clinical research and promotes ethical principles of research 1176

13.9 Evaluates evidence based findings for optimal application to practice. 1177

13.10 Disseminates evidence based findings to improve outcomes. 1178

61




13.11 Performs rigorous critique of current evidence to drive quality nursing practice. 1182

13.12 Promotes a climate of collaborative research and clinical inquiry to promote oncology 1183

and oncology nursing research. 1184

13.13 Promotes incorporation of knowledge synthesized from evidence-based reviews into 1185

practice changes and analyzes practice changes to generate new testable hypotheses and 1186

knowledge 1187

13.14 Contributes to nursing and scientific knowledge by research participation and/or data 1188

synthesis, observations, and other clinical evidence. 1189

62

Standard 14. Quality of Practice 1190

Description 1191

The oncology nurse systematically evaluates the quality, safety, and effectiveness of 1192

oncology nursing practice within all practice settings and across the continuum of cancer care. 1193

Competencies 1194


14.1 Ensures that nursing practice is safe, effective, efficient, equitable, timely, and patient-1196

centered (IOM, 1999; IOM, 2001). 1197

14.2: Identifies gaps in quality and seeks information about quality initiative to improve 1198

outcomes. 1199

14.3: Participates in quality and assessment and improvement activities. 1200

14.4: Participates in interprofessional teams to address organizational barriers to quality 1201

outcomes. 1202

14.5: Participates in collaborative efforts to identify and address issues that do not enhance 1203

patient care or outcomes. 1204

14.6 Incorporates evidence-based knowledges into standards of care, protocols and 1205

procedures. 1206

14.7 Collects and evaluates data to monitor the quality of nursing practice 1207

14.8: Evaluates patient satisfaction data to improve outcomes. 1208

14.9: Participates in critical review of policies, procedures, and guidelines to improve 1209

outcomes. 1210

14.10 Relies on results of quality monitoring to implement practice change. Participates in 1211

ongoing monitoring to evaluate impact of such changes. 1212

63

14.11 Disseminates information about practice that reflects quality and performance 1213

improvement initiatives. 1214

14.12 Earns professional certification when eligible 1215




14.13 Contributes nursing perspective in quality initiatives by providing leadership and 1219

expertise in evaluation of current practices to derive quality cancer patient care. 1220

14.14 Provides leadership and expertise in identifying, monitoring, changing, and 1221

implementing standards of evidence-based oncology practice to improve care for patients and 1222

caregivers. 1223

14.15 Uses available benchmarks to evaluate practice at the individual, departmental, or 1224

organizational level. 1225

14.16 Provides leadership in design and implementation of innovative quality improvement 1226

projects that improve health outcomes. 1227

14.17 Disseminates information about quality driven practice changes using distribution 1228

methods appropriate for each audience. 1229




14.18 Applies knowledge obtained from advanced preparation, as well as current research 1233

and evidence-based information, to clinical decision-making at the point of care to achieve 1234

optimal health outcomes. 1235

64

Standard 15. Professional Practice Evaluation 1236

Description 1237

The oncology nurse consistently evaluates his or her own and others' nursing practice in 1238

relation to national oncology nursing professional standards and guidelines, the state nurse 1239

practice act, relevant state- wide regulatory requirements, and job-specific performance 1240

expectations. 1241

Competencies 1242


15.1 Engages in self-reflection and self-evaluation of nursing practice on a regular basis, 1244

identifying areas of strength and areas in which professional growth would be beneficial. 1245

15.2 Engages in formal evaluation and ongoing performance appraisal. 1246

15.3 Routinely seeks feedback from interprofessional team members and patients to identify 1247

strengths and areas for improvement in knowledge, attitudes, and clinical skills. 1248

15.4 Identifies growth areas and sets personal goals for professional development. 1249

15.5 Formulates a plan with leadership to achieve the goal; modifies practice in response to 1250

evaluation of the implemented plan and obtains necessary education or assistance to meet 1251

learning and performance goals. 1252

15.6 Ensures that nursing practice is consistent with regulatory, professional, and institutional 1253

requirements pertaining to licensure, relevant statutes, rules, and regulations. 1254

15.7 Provides evidence of goal Completion during formal evaluation with rationale for 1255

practice decisions and actions. 1256

15.7 Promotes interprofessional evidence based practice when contributing to organizational 1257

policies and procedures 1258

65

15.9 Provides peers and others with formal and informal constructive feedback regarding 1259

their practice or role performance. 1260

15.10 Serves as a role model, mentor, and preceptor for new oncology nurses. 1261

15.11 Promotes oncology nursing certification by encouraging and mentoring colleagues 1262

15.12 Maintains a professional record for self-evaluation and for evaluation by practice 1263

institution, licensing agencies, and certification organizations. 1264




15.13 Participates in formal and informal appraisal of professional colleagues to further 1268

strengthen overall healthcare team performance and effectiveness. 1269

1270

66

Standard 16. Resource Utilization 1271

Description 1272

The oncology nurse considers factors related to safety, efficiency, effectiveness, and cost in 1273

planning and delivering care to patients. 1274

Competencies 1275


16.1 Assesses patient care needs and resources available to achieve desired outcomes. 1277

16.2 Assists the patient and interprofessional team in factoring costs, risks, and benefits in 1278

decisions about care. 1279

16.3 Assists the patient in identifying and securing appropriate services and resources 1280

throughout their care continuum. 1281

16.4 Participates in new product evaluation to determine safety, effectiveness, and cost-1282

benefit analysis. 1283

16.5 Integrates technology and systems (e.g. telehealth and mobile health technologies) into 1284

practice to improve outcomes. 1285

16.6 Critiques the adequacy of existing resources and identifies resource gaps. 1286

16.7 Advocates for safe staffing levels, nurse-patient ratios, and nurse competencies to meet 1287

patients’ needs. 1288

16.8 Demonstrate proficiency and appropriate use of the organization’s clinical informatics 1289

system. 1290


67



16.9 Recognizes and develops plan to address inconsistencies in patient care needs and 1294

required and available resources. 1295

16.10 Analyzes and participates in decisions to promote a work environment that supports 1296

efficient care and cost-effective resource use. 1297

16.11 Identify and utilize cost-effective, culturally sensitive, quality-based programs that 1298

promote cancer prevention and early detection activities to reduce the costs, morbidity, and 1299

mortality associated with a cancer diagnosis. 1300

16.12 Serves as a consultant to research and identify appropriate resources utilization. 1301

1302

68

Standard 17. Environmental Health 1303

Description 1304

The oncology nurse practices in an environmentally safe and healthy manner. 1305

Competencies 1306


17.1 Actively engages in practices to promote a workplace and practice environment that is 1308

safe and healthy. 1309

17.2 Adheres to regulatory requirements, related organizational policies, and ONS standards 1310

and guidelines for safe handling and administration of chemotherapy and immunotherapy agents, 1311

as well as practices to minimize radiation exposure. 1312

17.3 Uses products or treatments consistent with evidence-based practice to reduce 1313

environmental threats. 1314

17.4 Provides patients and caregivers with resources to limit hazardous drug environmental 1315

exposure. 1316




17.5 Provides leadership and promotes the development of a workplace environment that 1320

emphasizes health promotion for employees, patients, and families. 1321

17.6 Establish and promote practices to promote safety for patients, caregivers, healthcare 1322

providers and the environment related to toxicity of cancer treatments. 1323

1324

69

References 1325

American Cancer Society [ACS]. (2017a). Cancer facts and figures 2017. Atlanta, GA: Author 1326

American Cancer Society [ACS]. (2017b). Our history: The early years. Retrieved from 1327

https://www.cancer.org/about-us/who-we-are/our-history.html 1328

American Society of Clinical Oncology [ASCO]. (2017). The state of cancer care in America, 2017: A 1329

report by the American Society of Clinical Oncology. Journal of Oncology Practice, 13, e353—e394. 1330

Centers for Disease Control and Prevention. (2017, August). Prescribing data. Retrieved from 1331

https://www.cdc.gov/drugoverdose/data/prescribing.html 1332

Centers for Medicare and Medicaid Services [CMS]. (2017). MACRA, delivery system reform, Medicare 1333

payment reform. Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-1334

Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-1335

APMs.html 1336

Dowell, D., Haegerich, T.M., & Chou, R. (2016.) CDC guideline for prescribing opioids for chronic pain 1337

United States, 2016. MMWR Recomm Rep 65(No. RR-1):1–49. Retrieved from 1338

https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm 1339

Haylock, P.J. (2011). Cancer nursing: The modern era. Oncology Nursing Forum, 38, E7-E14. 1340

International Society of Nurses in Cancer Care (ISNCC). (2016-2017). Nursing and the World Cancer 1341

Declaration. Retrieved from 1342

http://c.ymcdn.com/sites/www.isncc.org/resource/resmgr/publications/Nursing_and_World_Cancer_1343

Dec.pdf 1344

Iseminger, K., Buratto, C. & Storey, S. (2016). Ethics consultation and education (pp. 157-181). In J.M. 1345

Erickson, & K. Payne (Eds.), Ethics in oncology nursing, Pittsburgh, PA: Oncology Nursing Society. 1346

Lusk, B. (2011). Nursing’s central role in the care of individuals with cancer: 1900-1940. Oncology 1347

Nursing Forum, 38, E1-6. 1348

https://www.cancer.org/about-us/who-we-are/our-history.html

https://www.cdc.gov/drugoverdose/data/prescribing.html

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html



https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

http://c.ymcdn.com/sites/www.isncc.org/resource/resmgr/publications/Nursing_and_World_Cancer_Dec.pdf

http://c.ymcdn.com/sites/www.isncc.org/resource/resmgr/publications/Nursing_and_World_Cancer_Dec.pdf

70

Lynaugh, J.E. (2008). Nursing the great society: The impact of the Nurse Training Act of 1964. Nursing 1349

History Review, 16, 13–28. 1350

McDonnell, K.K. (2011). Driving forces that transformed the care of individuals with cancer from 1900-1351

1940. Oncology Nursing Forum, 38, E15-20. 1352

National Academy of Medicine. (2017). First do no harm. Washington, DC: National Academy of 1353

Sciences. 1354

National Council of State Boards of Nursing [NCSBN]. (2017). The 2017 environmental scan. Journal of 1355

Nursing Regulation, 7(Suppl.), S2-S36. 1356

National Cancer Institute [NCI]. (2016). National Cancer Act of 1937. Retrieved from 1357

https://www.cancer.gov/about-nci/legislative/history/national-cancer-act-1937 1358

National Comprehensive Cancer Network. (2017 v.2). NCCN Clinical Practice Guidelines in Oncology 1359

Palliative Care. Retrieved from https:www.nccn.org/professionals/physician_gls/pdf/palliative.pdf 1360

Nielsen, B.B., Scofield, R.S., Mueller, S., Tranin, A.S., Moore, P., & Miller Murphy, C. (1996). 1361

Certification of oncology nurses: A history. Oncology Nursing Forum, 23, 701-708. 1362

O’Brien, M., Stricker, C. T., Foster, J.D., Ness, K., Arlen, A.G., & Schwartz, R.N. (2014). Navigating the 1363

seasons of survivorship in community oncology. Clinical Journal of Oncology Nursing, 18, 9-14. doi: 1364

10.1188/14.CJON.S1.9-14 1365

Oncology Nursing Society (ONS). (2016a). About us. Retrieved from https://www.ons.org/about 1366

Oncology Nursing Society (ONS). (2016b). Access to quality cancer care. Retrieved from 1367

https://www.ons.org/advocacy-policy/positions 1368

Oncology Nursing Society (ONS). (2016c). Palliative care for people with cancer. Retrieved from 1369

https://www.ons.org/advocacy-policy/positions 1370

Schulmeister, L. (2016). Technology and the transformation of oncology care. Seminars in Oncology 1371

Nursing, 32, 99-109. 1372

Smith, C.R., Yates, J.J. & Ewing, N.R. (2017). Caring for the cancer survivor. in J. Eggert (Ed.) Cancer 1373

basics (2nd ed., pp. 735-757), Pittsburgh, PA: Oncology Nursing Society. 1374

https://www.cancer.gov/about-nci/legislative/history/national-cancer-act-1937

https://www.ons.org/about

https://www.ons.org/advocacy-policy/positions

71

Wilson,K. (2005). The evolution of the role of nurses: The history of nurse practitioners in pediatric 1375

oncology. Journal of Pediatric Oncology Nursing, 22, 250-253. 1376

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